Objective To explore potential differences in food shopping behaviors and healthy food availability perceptions between residents living in areas with low and high food access. Design A cross-sectional telephone survey to assess food shopping behaviors and perceptions. Data from an eight-county food environment field census used to define the CDC (Centers for Disease Control and Prevention) healthier food retail tract and USDA ERS (United States Department of Agriculture Economic Research Service) food desert measure. Participants 968 residents in eight South Carolina counties. Main Outcome Measures Residents’ food shopping behaviors and healthy food availability perceptions. Analysis Linear and logistic regression. Results Compared to residents in high food access areas, residents in low food access areas traveled further to their primary food store (USDA ERS: 8.8 vs. 7.1 miles, p=0.03; CDC: 9.2 vs. 6.1 miles, p<0.001), accumulated more total shopping miles per week; CDC 28.0 vs. 15.4 miles, p<0.001) and showed differences in perceived healthy food availability (p<0.001) and shopping access (p<0.001). Conclusions and Implications These findings lend support to ongoing community and policy interventions aimed at reducing food access disparities.